Substance abuse in patients with attention-deficit/hyperactivity disorder

Substance use disorder (SUD) is a common comorbidity of attention-deficit/hyperactivity disorder (ADHD) that is frequently seen during adolescence. Physicians who treat patients with ADHD need to be aware of both the behavioral and medical signs of substance abuse and closely screen their patients for SUD. Optimal treatment of the symptoms of ADHD is the most effective way to reduce the incidence of SUD, but the use of stimulants, the first-line therapy for ADHD, is associated with an appreciable degree of abuse and misuse of therapeutic drugs. Cardiovascular and psychiatric risks with ADHD drugs have resulted in recent labeling changes for these drugs. A correct diagnosis of ADHD is important in validating the use of stimulant medication. New strategies for effectively treating ADHD that may minimize the risk for drug abuse are being developed and include extended-release formulations of currently used drugs, new nonstimulant drugs for the treatment of ADHD, and novel prodrugs that optimize therapeutic plasma concentrations of drugs. Nonmedication or psychosocial treatments, especially for adult ADHD, are also available. Further assessment of these strategies should permit the development of new approaches to the treatment of ADHD that reduce the risk for abuse and misuse of stimulant medications.